Archive for the ‘WHO – World Health Organization’ Category
Australia to begin first human test of swine flu vaccine
(CNN) — The first human trials of a swine flu vaccine are expected to start in Australia Wednesday, as the World Health Organization confirmed that more than 700 people had died from the virus worldwide.
A scientist examines samples from suspected swine flu patients at a WHO laboratory in Melbourne, Australia.
Melbourne-based company CSL Ltd. plans to test a vaccine for the H1N1 virus, also known as swine flu, on 240 volunteers, a company representative said.The test will be conducted on healthy adults between the ages of 18-64. Participants will receive two shots three weeks apart and will undergo blood tests to determine if they are generating an appropriate immune response to the virus, the company said.
“We appreciate that new influenza strains like the ‘swine flu’ can surprise us with properties that mean they might require higher dosing and two injections rather than one to provoke the desired level of immune response in humans,” said Dr. Russell Basser, global director of clinical development for CSL.
The World Health Organization revealed Tuesday that more than 700 people had died after contracting the virus, 260 more than the latest death toll, released July 6. The jump in the death toll is due simply to the two-week gap in reporting cases, a WHO spokeswoman explained.
The H1N1 virus has spread around the world with unprecedented speed, according to the WHO. Past influenza viruses have needed more than six months to spread as widely as the current H1N1 virus has spread in less than six weeks, it said.
Because there are so many cases emerging so quickly, the WHO changed its reporting guidelines last week. It decided to stop giving a tally of cases and focus instead on identifying unusual patterns. The counting of all cases is no longer essential because it is exhausting countries’ resources, the organization said Monday, commenting on the policy change.
While the virus is spreading quickly, the WHO offered some reassurance to those concerned about the disease. It said the virus has so far been characterized by mild symptoms in most patients, who usually recover — even without medical treatment — within a week of developing symptoms.
Meanwhile, a group of British children and teachers quarantined for almost one week in a Beijing hotel because of swine flu fears have been allowed to leave their hotel.
A spokesman from Britain’s Foreign Office could not confirm the number of children and teachers released from quarantine, but said they were among a group of 111 that was sequestered in a Beijing hotel six days ago.
The students and teachers came from various schools in Britain and were all traveling to China together as members of the same British school association, the Specialist Schools and Academies Trust.
Twelve children were hospitalized and diagnosed with the H1N1 virus, commonly known as swine flu. One child is in the hospital awaiting test results to confirm the virus, the Foreign Office said.
The group released from quarantine Tuesday will now be moved to a different hotel, the Foreign Office said. The second group is due to be released from quarantine Wednesday, the Foreign Office said.
WHO declared H1N1 a global pandemic on June 11. More than 120 countries have reported cases of human infection since the virus was first identified in Mexico in April. There are more than 98,000 documented cases worldwide.
Airlines stop swine flu victims flying
LONDON, England (CNN) — British airlines have put into effect measures to stop people with swine flu boarding flights in a bid to prevent the virus from spreading further.
Medical screening for the swine flu virus has been introduced at many airports.
British Airways said there had been a “very small number of cases” where people who had checked in with symptoms of H1N1 had been advised not to travel after having medical checks.
Virgin Atlantic also said victims would not be allowed to board one of its planes without a fit-to-fly certificate from their doctor or a hospital, though there had been no cases yet.
The World Health Organization declared the virus a global pandemic June 11. More than 120 countries have reported cases of human infection. About 98,000 cases have been documented worldwide, with 440 deaths, according to the WHO.
With 29 deaths and a huge rise in the number of cases, Britain has the worst swine flu figures in Europe.
Eight British schoolchildren remained in hospital in China on Monday after contracting swine flu on a trip to the country, the Foreign Office said. The teenagers were diagnosed with the H1N1 virus in Beijing. More than 50 of their classmates and teachers are also quarantined in a hotel.
Medical screening for the swine flu virus has been introduced at many airports around the world for passengers arriving on international flights but there are concerns that many people may not be aware they are infected.
Those who do have symptoms have been advised by Britain’s health authorities to delay their journeys until the signs have cleared up.
“We have a medical team within the airline as well as a contingency planning group which has met for the past few years to look at the issue of a flu pandemic,” A British Airways spokeswoman said.
“We have a wide range of contingency plans in place which we can use depending on how the situation may evolve.
“If we have concerns about a customer or the customer is concerned, then we have a 24-hour medical service we can call to give advice to staff.
“They will speak to the customer and an assessment will be made about their fitness to fly.
“There have been a number of cases where we have advised customers not to fly on the basis of their diagnosis or symptoms of H1N1.”
BA told CNN Monday though that it was “business as usual” and all flights were operating normally.
Virgin Atlantic spokesman Paul Charles said: “If there are signs of something being wrong, be it excessive sneezing or coughing, not looking well, high temperature, then the airport staff can call in a medical team for extra advice.
“If the medical team believe there are reasons not to fly, the passenger will be asked to produce a fit to fly certificate from their doctor or a hospital, and they will be put at our cost on to the next available flight.”
Swine flu has spread so rapidly and extensively around the globe that the World Health Organization is changing tactics against the H1N1 virus, including stopping a tally of cases and focusing on unusual patterns.
“At this point, further spread of the pandemic, within affected countries and to new countries, is considered inevitable,” the WHO said.
The counting of all cases is no longer essential because it is exhausting countries’ resources, the organization said.
“In some countries, this strategy is absorbing most national laboratory and response capacity, leaving little capacity for the monitoring and investigation of severe cases, and other exceptional events.”
Monitoring is still required, the organization urged, but should focus on exceptional patterns.
“Because the numbers of cases have increased in so many countries, it is very hard to keep up,” Keiji Fukuda, WHO assistant director-general, said earlier this month.
Laboratories have been inundated with testing requests and the virus is showing up in most lab tests in countries with major outbreaks, he said.
The organization said it will not issue global tables showing confirmed cases for countries that have reported cases, according to the release.
However, it will still report on nations that have not had cases so that its presence can be confirmed. “WHO will continue to request that these countries report the first confirmed cases and, as far as feasible, provide weekly aggregated case numbers and descriptive epidemiology of the early cases.”
Meanwhile, governments should should be on the lookout for unusual patterns, the organization said.
While most patients have reported mild symptoms, a rise in severe symptoms or respiratory ailments that require hospitalization should be cause for concern, it said. Governments should also pay attention to unusual patterns linked to fatal cases, the WHO said.
Any changes in prevailing patterns should be flagged, including a rise in school and job absenteeism, and an increase in visits to the emergency room.
An overwhelmed health system may mean there is a rise in severe cases, the organization said.
WHO Chief declares Swine Flu Speading with ‘Unprecedented Speed’
By Shirley S. Wang
July 16, 2009
The World Health Organization says it’s going to stop counting cases of the new H1N1 flu, according to a note posted on its website.
The virus is spreading with “unprecedented speedâ€, wrote the WHO. “At this point, further spread of the pandemic, within affected countries and to new countries, is considered inevitable.â€
But countries need to continue to closely monitor “unusual events†like clusters of severe virus infections or unusual patterns of these serious cases. These signals might come from noticing an increase in the number of people staying home from work or school, or by an increase in emergency room visits.
H1N1 pandemic spreading too fast to count – WHO
 
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Thu Jul 16, 2009 1:10pm EDT
 * H1N1 virus has spread more quickly than other pandemics
* WHO says pointless to count individual cases
* But countries should track deaths, unusual patterns
By Stephanie Nebehay
GENEVA, July 16 (Reuters) – The World Health Organisation (WHO) said on Thursday that the H1N1 flu pandemic was the fastest-moving pandemic ever and that it was now pointless to count every case.
The United Nations agency, which declared an influenza pandemic on June 11, revised its requirements so that national health authorities need only report clusters of severe cases or deaths caused by the new virus or unusual clinical patterns.
“The 2009 influenza pandemic has spread internationally with unprecedented speed. In past pandemics, influenza viruses have needed more than six months to spread as widely as the new H1N1 virus has spread in less than six weeks,” it said in a statement on the new strain, commonly known as swine flu.
It has become nearly impossible for health authorities and laboratories to keep count of individual cases — which have mostly been mild — as the virus spreads, according to the 193 member-state agency.
Flu experts say at least a million people are infected in the United States alone, and the WHO says the pandemic is unstoppable.
“It is very much agreed that trying to register and report every single case is a huge waste of resources,” WHO spokesman Gregory Hartl said.
Such tracking has limited authorities’ capacity to investigate serious cases and is no longer essential to monitor the level or nature of the risk posed by the virus, WHO said.
However, all countries should still closely monitor unusual clusters of severe or fatal infections from the pandemic virus, clusters of respiratory illness requiring hospitalisation or unexplained or unusual clinical patterns.
“Signals to be vigilant for include spikes in rates of absenteeism from schools or workplaces, or a more severe disease pattern, as suggested by, for example, a surge in emergency department visits,” it said.
Britain reported on Thursday that 29 people had died to date after contracting the virus. Health Minister Andy Burnham said this month the government was projecting more than 100,000 new cases a day of the flu in the country by the end of August.
The WHO will no longer issue global tables showing the numbers of confirmed cases for all countries — which stood at 94,512 cases with 429 deaths as of its last update on July 6.
Instead, it will issue regular updates on the situation in newly affected countries, which should report the first confirmed cases, weekly figures and epidemiological details.
Countries should still test a limited number of virus samples weekly to confirm that disease is actually due to the pandemic virus and to monitor any virological changes that may be important for the development of vaccines, it said.
At least 50 governments have placed orders for vaccines against the new H1N1 strain or negotiating with drug makers, WHO vaccine chief Marie-Paule Kieny told Reuters. [ID:nLG225946]
The WHO does not report figures for cases of seasonal influenza, which it says is linked to 250,000 to 500,000 deaths a year globally. (For the WHO statement go to: here) (Additional reporting by Peter Griffiths in London)
WHO Chief Warns – Swine Flu “Unstoppable”!
Swine flu will be biggest pandemic ever, warns world health chiefAs swine flu sweeps the planet, Margaret Chan, head of the World Health Organisation, tells how she is leading the battle against it – and the personal price she is paying.
Chan’s war has arrived with a vengeance. A 2007 WHO report, A Safer Future, estimated that a flu pandemic could affect more than 1.5 bn people, or 25% of the world’s population. Could swine flu be that big? “Quite likely. Quite likely. But it probably won’t happen in one run. It will probably come back [in two or three waves].”
How does she expect it to compare to other pandemics? “In terms of the number of countries affected and the number of people infected, this has got to be the biggest.”  read more here
WHO recommendations on pandemic (H1N1) 2009 Vaccines
13 JULY 2009 | GENEVA — On 7 July 2009, the Strategic Advisory Group of Experts (SAGE) on Immunization held an extraordinary meeting in Geneva to discuss issues and make recommendations related to vaccine for the pandemic (H1N1) 2009.
SAGE reviewed the current pandemic situation, the current status of seasonal vaccine production and potential A(H1N1) vaccine production capacity, and considered potential options for vaccine use.
The experts identified three different objectives that countries could adopt as part of their pandemic vaccination strategy:
Protect the integrity of the health-care system and the country’s critical infrastructure; reduce morbidity and mortality; and reduce transmission of the pandemic virus within communities.
Countries could use a variety of vaccine deployment strategies to reach these objectives but any strategy should reflect the country’s epidemiological situation, resources and ability to access vaccine, to implement vaccination campaigns in the targeted groups, and to use other non-vaccine mitigation measures.
Although the severity of the pandemic is currently considered to be moderate with most patients experiencing uncomplicated, self-limited illness, some groups such as pregnant women and persons with asthma and other chronic conditions such as morbid obesity appear to be at increased risk for severe disease and death from infection.
Since the spread of the pandemic virus is considered unstoppable, vaccine will be needed in all countries. SAGE emphasized the importance of striving to achieve equity among countries to access vaccines developed in response to the pandemic (H1N1) 2009
The following recommendations were provided to the WHO Director-General:
All countries should immunize their health-care workers as a first priority to protect the essential health infrastructure. As vaccines available initially will not be sufficient, a step-wise approach to vaccinate particular groups may be considered. SAGE suggested the following groups for consideration, noting that countries need to determine their order of priority based on country-specific conditions: pregnant women; those aged above 6 months with one of several chronic medical conditions; healthy young adults of 15 to 49 years of age; healthy children; healthy adults of 50 to 64 years of age; and healthy adults of 65 years of age and above.
Since new technologies are involved in the production of some pandemic vaccines, which have not yet been extensively evaluated for their safety in certain population groups, it is very important to implement post-marketing surveillance of the highest possible quality. In addition, rapid sharing of the results of immunogenicity and post-marketing safety and effectiveness studies among the international community will be essential for allowing countries to make necessary adjustments to their vaccination policies.
In view of the anticipated limited vaccine availability at global level and the potential need to protect against “drifted” strains of virus, SAGE recommended that promoting production and use of vaccines such as those that are formulated with oil-in-water adjuvants and live attenuated influenza vaccines was important.
As most of the production of the seasonal vaccine for the 2009-2010 influenza season in the northern hemisphere is almost complete and is therefore unlikely to affect production of pandemic vaccine, SAGE did not consider that there was a need to recommend a “switch” from seasonal to pandemic vaccine production.
WHO Director-General Dr Margaret Chan endorsed the above recommendations on 11 July 2009, recognizing that they were well adapted to the current pandemic situation. She also noted that the recommendations will need to be changed if and when new evidence become available.
SAGE was established by the WHO Director-General in 1999 as the principal advisory group to WHO for vaccines and immunization. It comprises 15 members who serve in their personal capacity and represent a broad range of disciplines from around the world in the fields such as epidemiology, public health, vaccinology, paediatrics, internal medicine, infectious diseases, immunology, drug regulation, programme management, immunization delivery, and health-care administration.
Additional participants in the SAGE meeting included members of the ad hoc policy advisory working group on influenza A(H1N1) vaccine, chairs of the regional technical advisory groups and external experts. Observers included industry representatives and regulators who did not take part in the recommendation process in order to avoid conflicts of interest.
WHO News – H1N1 Pandemic Update
 
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Transcript of virtual press conference with:
 Dr Keiji Fukuda, Assistant Director-General ad Interim for Health Security and Environment,
World Health Organization
7 July 2009
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Welcome to the WHO virtual press conference for July 7 2009.
 Dr Keiji Fukuda:Â
 Good afternoon everybody. What I would like to do is to start off with the usual situation update and then talk a little bit about surveillance recommendations and also talk a little bit about some of the oseltamavir-resistant viruses that we have seen in the past few weeks.
In terms of the current situation with the influenza H1N1 pandemic, we are now seeing that 137 countries, territories, and areas are reporting laboratory-confirmed cases to WHO. This includes 120 countries in that group. We have also received over 98 000 reports of laboratory-confirmed cases and over 440 deaths among those cases. As we go into this pandemic, it is important to point out that the situation continues to evolve quite rapidly.
We are definitely in a period in which the situation is changing both globally as well as within many different countries.
Now in the next few days, WHO will be issuing some updated surveillance recommendations for countries and I just wanted to talk about these and explain the reason for it. Because the situation is evolving globally, we are now at a place in which changing some of the surveillance approaches probably makes a lot of sense for many countries. For countries which are having cases, we will be recommending that they begin to move away from trying to laboratory test all individual cases and really move towards larger national indicators of disease, for example following influenza-like illnesses, following pneumonia cases and so on. The reason for this is that because the numbers of cases have increased in so many countries, it is very hard to keep up and we now need to move to these kinds of indicators, to keep following along with the trend in the pandemic to see how activity is going, whether it is going up or down. It also will make it easier for countries in many ways because it will ease the burden on the laboratories and make testing much less of a chore than it has been for many of the countries.
Now in countries that do not have cases, however, we will be continuing to recommend that people who are suspected to have pandemic influenza be tested so that the presence of this virus can be confirmed in countries. And in addition, in all countries we will continue to stress that if you have unusual cases, so perhaps unusually severe cases, or perhaps unusual clusters of cases, or perhaps patients who are developing symptoms which have not been reported before, that these kinds of cases continue to be tested, to confirm that it is due to pandemic influenza. And then, that the cases in the clusters be investigated so we understand whether there are changes going on in the epidemiology and in the clinical picture of the illness. We will be putting up the updated guidance within the next few days and hopefully this will help with the monitoring globally for this pandemic.
A second issue that I wanted to talk about is that in the last two weeks or so, we have now heard about three oseltamivir-resistant viruses which have been isolated from persons in Denmark, in Japan and in Hong Kong. The isolation of these cases has raised some questions about what are the implications of this, and right now these examples of oseltamivir-resistance remain sporadic cases – we do not see any evidence of widespread movement of oseltamivir-resistant viruses. And so far, we have not heard of any additional viruses, including among close contacts of these persons.
There are a couple of important points to emphasize about these current oseltamivirresistant viruses. In the first place, it is not unexpected that we will see some viruses that are resistant to this drug. This normally happens when you treat any infection with any drug.
The important point here is that we are continually monitoring the situation to make sure that we are not seeing the start of any large-spread movement of such viruses. Again, I want to emphasize at this point we do not see this: we are just seeing sporadic cases but we will be monitoring the situation very closely. These viruses are also sensitive to the other neuraminidase inhibitor drug called zanamavir and then, these resistant viruses are also due to mutations – they do not represent any kind of mixture with the current seasonal influenza viruses so right now it looks like that these are spontaneous mutations in these patients.
Probably the single most important point about the oseltamivir-resistant cases is that, at this point, we are not recommending any clinical changes to the approach of treating patients and that is the most important point for physicians and countries to know.
The last thing I will mention is that – many of you know – that we are in the middle of an important meeting called SAGE, which is going on in Geneva. I left this meeting today – it continues on – and we will be discussing this meeting more in depth over the next few days, but will not be going into it in any detail today. So, with that, let me turn it over for any questions.
Martin Ensureck: I have a question about the naming of the virus. I read yesterday in a posting on ProMed that the World Health Organization, along with FAO and OIE, have chosen, once again, a new name and I wonder if you can explain to me when that decision was taken, by whom and why exactly this name, because already I have talked to some people who say it is not exactly a catchy name, it won’t catch on the way that you would hope if you want to end the confusion about what the pandemic and the virus should be called?
Dr Fukuda: As you know, since the emergence of the pandemic, the name of the virus has been a difficult issue for many reasons. In the past, we have seen how the naming of viruses by location can stigmatize those locations and we have also seen in this and in other episodes where associating the virus with one animal species or another, can really cause both anxiety and then fears about food and in this particular instance, about pork.
So, in recognition of those issues, what WHO, FAO and OIE did, actually some weeks ago, was to get together several of the experts who work in these organizations and with many of the laboratory experts who work with these organizations, and then we had a meeting – a virtual meeting – in which these issues were discussed and one of the things that we wanted to do was make sure that any naming of the virus was scientifically accurate but also would avoid any kind of adverse reactions to the name or to minimize those as much as possible.
Based on those discussions, what the experts decided – calling this a pandemic H1N1/09 virus – was a good way to distinguish it from the current seasonal H1N1 viruses and to do so, in a way which was scientifically sound, but also would avoid some of the stigma associated with other options.
Rebecca Smith, The Daily Telegraph: In the UK we have already moved from containment to mitigation and have stopped laboratory testing of all cases and moved to clinical diagnosis, but when that happened last week, we had some projections from officials and ministers that we could be seeing 100 000 cases per day in the UK by as early as next month. Now that is based on current trends of a doubling of the number of cases every week, but that would suggest that the pandemic would be over and done with probably by Christmas. Can you explain a little bit about how the pattern of disease is expected to continue once you move from containment to mitigation.
Dr Fukuda: Probably the most important concept to understand here is that depending  where you are in the world – for example in the Southern Hemisphere where they are in the winter months and entering into their regular influenza season – they may see a pattern which is different from what is being seen in the Northern Hemisphere in countries like the UK, North America and so on. Now in the UK, as in many of the North American countries – Canada, Mexico and the United States – there has been quite widespread activity, or a lot of activity of this pandemic influenza virus, and right now it is at a typical point of the year where the activity should be pretty low, but the activity is quite high because it is a pandemic situation for these countries, and I think that it is likely that infections will continue in these countries.
However, I think it is a little bit hard to predict what the pattern will be for the remainder of the summer. It is possible that the UK and other countries in the Northern Hemisphere could continue to see fairly high levels of activity, but it is also quite possible that the levels of activity could go down because it is in the summer months. And then, again, it is a guess about what will happen in the fall and winter time, although it is more likely that activity will again pick up in the fall and winter time in the Northern Hemisphere countries. The same general perspective holds for the Southern Hemisphere countries where we can expect to see increased activity during the winter months but they may also see unusually high activity in the summer months. We are not positive about how any of this will develop over the next several months and so this is why keeping up with the surveillance is so important so we can monitor it closely.
Maria Cheng Associated Press: I have a couple of questions about the Tamiflu-[oseltamivir]-resistant viruses that have been picked up. I wondered if you might be any more concerned about the case that was detected in Hong Kong since that was apparently in a patient who had not been treated with oseltamivir, suggesting that maybe that the virus once it developed resistance might be … to spread and if you have any particular concerns about the potential reassorting with seasonal H1N1 which has shown a Tamiflu- [oseltamivir]-resistance.
Dr Fukuda: I think for that it is hard to know whether the virus isolated from the person in Hong Kong has any more implications than the viruses isolated from the two other people who were taking prophylactic doses of oseltamivir. If we look at the virus which was isolated from the person in Hong Kong, it has the same mutation as the resistant viruses isolated from the person in Japan and in Denmark. Again, it is not clear whether that mutation occurred spontaneously in the person who is infected in Hong Kong or whether they got that virus from somebody else who may have been taking oseltamivir. At this point, there is a great deal of attention to looking at the viruses coming out of the west coast area in which the person from Hong Kong was residing, but so far there are no other detections of resistant viruses in that area and in all three of the countries so far we have no evidence at all of any other resistant viruses. I think at this point it is not clear whether there is any differences in the implications of these three viruses.
In terms of the question about reassortment, I think that reassortment among influenza viruses is always a possibility and therefore always of concern. Again, I think that the bottom line here is that the major thing that we can do is to continue to monitor these viruses, continue to characterize them, look at their genetic composition and see if there is any evidence of reassortment with any of the other viruses, but again, so far, we do not see any such evidence.
Marion Falco, CNN Atlanta: My question may be a little basic but if you are not, and so  forgive me for that, if you are not requiring testing in the countries that already have well established numbers of cases, then how are you distinguishing between seasonal flu and this particular flu. I mean how are you going to separate the numbers?
Dr Fukuda: It is not that we are recommending not doing any testing at all. In fact when the guidance comes out, what it will suggest is what countries are to do is tailor down their testing so that they are not trying to test everybody but certainly keeping up testing of some people for exactly the kinds of reasons that you bring up. When people get sick with an influenza-like illness it will be important for us to know whether is it caused by the pandemic virus or whether is caused by seasonal viruses. What we are indicating is that if you ratchet down the level of testing we will still be able to figure that out and so we do not need to test everybody for that, but we will continue to recommend some level of testing – at a lower level of people who continue to get sick.
Mika Ruitch, CDF: I have a question about the vaccine, you have not really mentioned anything. I understand that the meeting in Geneva is still going on about that but we have gone a really huge discussion here in Germany about it and I was wondering whether there is anything you can recommend to countries, whether to order or not already the vaccines.
Dr Fukuda: This is the SAGE meeting which is going on today and again, the meeting is actually still going on, so I think it is premature to make any reports on that meeting because it has not concluded . The meeting itself will end in recommendations which will go to the Director-General of WHO to look at, so if you can wait for a few days then we will be hearing more about the outcomes and recommendations of that meeting.
Tom Mo, Los Angeles Times: Can you give us a thumbnail description of what is going on in the Southern Hemisphere now?
Dr Fukuda: In the Southern Hemisphere we have seen activity occurring in a number of countries and similar to what we saw in the Northern Hemisphere, it varies a little bit from country to country. For example, a few weeks ago, Australia was reporting pandemic activity occurring quite heavily in some parts of Australia – in the Victoria area – whereas it was at lower levels in other parts of Australia for a while, then began picking up. In South America, there are viruses which have been isolated from most of the countries there, however much of the heaviest activity has occurred in Chile first and then more recently in Argentina. Again we are seeing a kind of mixed picture of activity in the Southern Hemisphere.
In Africa, if we go back a few weeks ago we would have said that there had been no viruses isolated from that continent but as of today 12 countries in the intervening period have reported detecting the virus. So, it is clearly spreading pretty quickly through the Southern Hemisphere; depending on the country you are seeing relatively lower levels of activity and then relatively higher levels of activity in some countries. Overall, I would still point out that for the Southern Hemisphere it is pretty early in their season so we still have a number of weeks to go through for that part of the world.
Tala Dolachi, Talk Radio Network News: You mentioned earlier that WHO is concerned about the surveillance systems and in particular looking at those national indicators. Of all the countries affected, are there any particular countries that WHO is focusing on now in terms of their inability to keep up to par with the national indicators?
Dr Fukuda: No, there is no particular country that we are looking at, and what we do focus on however is that if there are countries that are requesting help from WHO or from other Member States in terms of assistance to strengthen their surveillance, then we certainly give as much attention to those countries as possible. This has really paid off.
If we go back to the couple of years period before this pandemic occurred, for example there is a lot of discussions with the number of states in Africa and there has been actually a great deal of preparedness work which has gone on in that continent, and I can say that the number of laboratories which have the capacity to test for these viruses has really increased significantly in Africa. As of today, we have two new National Influenza Centres in Africa – one in Cameroon and one in Côte d’Ivoire – and so, although surveillance is definitely not optimal everywhere in the world, I would say that surveillance is definitely much better than it was three or four years ago. We will continue to try to build that capacity everywhere in the world where the countries are requesting help.
Aileen Gobay, CBC Montreal: I am sorry – the line was very bad and when you talked about the new name of the virus I did not catch it so can you repeat this information for me please?
Dr Fukuda: We are calling it the pandemic H1N1/09 virus. This refers to the fact that it is a pandemic influenza virus. If you look at the scientific subtype, it is an H1N1 virus, and the 09 refers to the current time period. Hopefully this will help to distinguish this virus from the seasonal H1N1 viruses.
Gabriella Sotomayor, Mexican Press Agency: How severe are the cases who receive the Tamiflu [oseltamavir]? And of all the cases in Argentina, in general terms, are those cases more severe like in the beginning in Mexico or is it moderate?
Dr Fukuda: I believe all three people have now recovered completely: They have uncomplicated illness. In terms of your second question, it is a little bit difficult for me to answer that so precisely. We know that in Argentina, for example, that most of the cases, as everywhere, have been uncomplicated influenza cases that is to say have not required special medical attention, or special medical care. However it is also true that in the last few weeks, there have been a number of serious cases hospitalizations and some deaths reported. I am sorry but I do not have exact numbers on my fingertips right now. It is a mixed picture similar to many other countries, I cannot tell you whether it is specifically like Mexico was at the beginning of the pandemic.
John Zeracostas: I wonder if you could give us a little bit of a bird’s eye view on the three-day modelling experts meeting here in Geneva on how they project the spread of this pandemic in the short and medium term?
Dr Fukuda: The purpose of that meeting which was held last week, was to further building up a WHO network in which modellers from around the world could work together on some of these pandemic problems, and other infectious disease problems. The meeting brought together over 20 different experts from most of the continents around the world, and what they discussed was some of the preliminary findings of some of the projects that they have been working on, some better ways in which modelling groups around the world could work together – could operationally be linked more closely together – and those were the primary areas of focus of that meeting. I’m sorry I cannot report on any specific project from that meeting, I was not there in attendance.
Lisa S________, The Telegraph News: I wanted to get back to you about the Southern Hemisphere situation, thanks for the snapshot on that. I wanted to see if you also are able to tell how the seasonal flu is doing there, how the pandemic flu is competing against it, what trends you are seeing, if you are able to tell at this point in the flu season, I know you said it was early, but just wondering what you are seeing so far?
Dr Fukuda: The countries are seeing a mixed picture depending on the country. For example, in Chile, it was just reported that over 99% of their influenza viruses are the new pandemic H1N1 virus. By contrast, in Australia, they see more of a mixed picture, where they are seeing both the pandemic H1N1 virus but they are also seeing a seasonal H3N2 virus that circulates there. Then, if we go down to South Africa, right now the seasonal influenza viruses are much more predominant than the pandemic influenza viruses. In the Southern Hemisphere, it is fair to say that there is a mixed picture. In another month or so, we will have again a much clearer picture about how the pandemic virus is spreading in the Southern Hemisphere and whether it is beginning to crowd out the seasonal influenza viruses in many countries or in just some countries.
In terms of the current situation with the influenza H1N1 pandemic, we are now seeing that 137 countries, territories, and areas are reporting laboratory-confirmed cases to WHO. This includes 120 countries in that group. We have also received over 98 000 reports of laboratory-confirmed cases and over 440 deaths among those cases. As we go into this pandemic, it is important to point out that the situation continues to evolve quite rapidly.
We are definitely in a period in which the situation is changing both globally as well as within many different countries.
Now in the next few days, WHO will be issuing some updated surveillance recommendations for countries and I just wanted to talk about these and explain the reason for it. Because the situation is evolving globally, we are now at a place in which changing some of the surveillance approaches probably makes a lot of sense for many countries. For countries which are having cases, we will be recommending that they begin to move away from trying to laboratory test all individual cases and really move towards larger national indicators of disease, for example following influenza-like illnesses, following pneumonia cases and so on. The reason for this is that because the numbers of cases have increased in so many countries, it is very hard to keep up and we now need to move to these kinds of indicators, to keep following along with the trend in the pandemic to see how activity is going, whether it is going up or down. It also will make it easier for countries in many ways because it will ease the burden on the laboratories and make testing much less of a chore than it has been for many of the countries.
Now in countries that do not have cases, however, we will be continuing to recommend that people who are suspected to have pandemic influenza be tested so that the presence of this virus can be confirmed in countries. And in addition, in all countries we will continue to stress that if you have unusual cases, so perhaps unusually severe cases, or perhaps unusual clusters of cases, or perhaps patients who are developing symptoms which have not been reported before, that these kinds of cases continue to be tested, to confirm that it is due to pandemic influenza. And then, that the cases in the clusters be investigated so we understand whether there are changes going on in the epidemiology and in the clinical picture of the illness. We will be putting up the updated guidance within the next few days and hopefully this will help with the monitoring globally for this pandemic.
A second issue that I wanted to talk about is that in the last two weeks or so, we have now heard about three oseltamivir-resistant viruses which have been isolated from persons in Denmark, in Japan and in Hong Kong. The isolation of these cases has raised some questions about what are the implications of this, and right now these examples of oseltamivir-resistance remain sporadic cases – we do not see any evidence of widespread movement of oseltamivir-resistant viruses. And so far, we have not heard of any additional viruses, including among close contacts of these persons.
There are a couple of important points to emphasize about these current oseltamivirresistant viruses. In the first place, it is not unexpected that we will see some viruses that are resistant to this drug. This normally happens when you treat any infection with any drug.
The important point here is that we are continually monitoring the situation to make sure that we are not seeing the start of any large-spread movement of such viruses. Again, I want to emphasize at this point we do not see this: we are just seeing sporadic cases but we willbe monitoring the situation very closely. These viruses are also sensitive to the other neuraminidase inhibitor drug called zanamavir and then, these resistant viruses are also due to mutations – they do not represent any kind of mixture with the current seasonal influenza viruses so right now it looks like that these are spontaneous mutations in these patients.
Probably the single most important point about the oseltamivir-resistant cases is that, at this point, we are not recommending any clinical changes to the approach of treating patients and that is the most important point for physicians and countries to know.
The last thing I will mention is that – many of you know – that we are in the middle of an important meeting called SAGE, which is going on in Geneva. I left this meeting today – it continues on – and we will be discussing this meeting more in depth over the next few days, but will not be going into it in any detail today. So, with that, let me turn it over for any questions.
Good afternoon everybody. What I would like to do is to start off with Martin Ensureck:
posting on ProMed that the World Health Organization, along with FAO and OIE, have chosen, once again, a new name and I wonder if you can explain to me when that decision was taken, by whom and why exactly this name, because already I have talked to some people who say it is not exactly a catchy name, it won’t catch on the way that you would hope if you want to end the confusion about what the pandemic and the virus should be called?
I have a question about the naming of the virus. I read yesterday in a Dr Fukuda:
been a difficult issue for many reasons. In the past, we have seen how the naming of viruses by location can stigmatize those locations and we have also seen in this and in other episodes where associating the virus with one animal species or another, can really cause both anxiety and then fears about food and in this particular instance, about pork.
So, in recognition of those issues, what WHO, FAO and OIE did, actually some weeks ago, was to get together several of the experts who work in these organizations and with many of the laboratory experts who work with these organizations, and then we had a meeting – a virtual meeting – in which these issues were discussed and one of the things that we wanted to do was make sure that any naming of the virus was scientifically accurate but also would avoid any kind of adverse reactions to the name or to minimize those as much as possible.
Based on those discussions, what the experts decided – calling this a pandemic H1N1/09 virus – was a good way to distinguish it from the current seasonal H1N1 viruses and to do so, in a way which was scientifically sound, but also would avoid some of the stigma associated with other options.
As you know, since the emergence of the pandemic, the name of the virus has Rebecca Smith, containment to mitigation and have stopped laboratory testing of all cases and moved to clinical diagnosis, but when that happened last week, we had some projections from officials and ministers that we could be seeing 100 000 cases per day in the UK by as early as next month. Now that is based on current trends of a doubling of the number of cases every week, but that would suggest that the pandemic would be over and done with probably by Christmas. Can you explain a little bit about how the pattern of disease is expected to continue once you move from containment to mitigation.
The Daily Telegraph: In the UK we have already moved from Dr Fukuda where you are in the world – for example in the Southern Hemisphere where they are in the winter months and entering into their regular influenza season – they may see a pattern which is different from what is being seen in the Northern Hemisphere in countries like the UK, North America and so on. Now in the UK, as in many of the North American countries – Canada, Mexico and the United States – there has been quite widespread activity, or a lot of activity of this pandemic influenza virus, and right now it is at a typical point of the year where the activity should be pretty low, but the activity is quite high because it is a pandemic situation for these countries, and I think that it is likely that infections will continue in these countries.
However, I think it is a little bit hard to predict what the pattern will be for the remainder of the summer. It is possible that the UK and other countries in the Northern Hemisphere could continue to see fairly high levels of activity, but it is also quite possible that the levels of activity could go down because it is in the summer months. And then, again, it is a guess about what will happen in the fall and winter time, although it is more likely that activity will again pick up in the fall and winter time in the Northern Hemisphere countries. The same general perspective holds for the Southern Hemisphere countries where we can expect to see increased activity during the winter months but they may also see unusually high activity in the summer months. We are not positive about how any of this will develop over the next several months and so this is why keeping up with the surveillance is so important so we can monitor it closely.
 : Probably the most important concept to understand here is that depending Maria Cheng Associated Press [oseltamivir]-resistant viruses that have been picked up. I wondered if you might be any more concerned about the case that was detected in Hong Kong since that was apparently in a patient who had not been treated with oseltamivir, suggesting that maybe that the virus once it developed resistance might be … to spread and if you have any particular concerns about the potential reassorting with seasonal H1N1 which has shown a Tamiflu-[oseltamivir]-resistance.: I have a couple of questions about the Tamiflu-Dr Fukuda Hong Kong has any more implications than the viruses isolated from the two other people who were taking prophylactic doses of oseltamivir. If we look at the virus which was isolated from the person in Hong Kong, it has the same mutation as the resistant viruses isolated from the person in Japan and in Denmark. Again, it is not clear whether that  mutation occurred spontaneously in the person who is infected in Hong Kong or whether they got that virus from somebody else who may have been taking oseltamivir. At this point, there is a great deal of attention to looking at the viruses coming out of the west coast area on which the person from Hong Kong was residing, but so far there are no other detections of resistant viruses in that area and in all three of the countries so far we have no evidence at all of any other resistant viruses. I think at this point it is not clear whether there is any differences in the implications of these three viruses.
In terms of the question about reassortment, I think that reassortment among influenza viruses is always a possibility and therefore always of concern. Again, I think that the bottom line here is that the major thing that we can do is to continue to monitor these viruses, continue to characterize them, look at their genetic composition and see if there is any evidence of reassortment with any of the other viruses, but again, so far, we do not see any such evidence.
: I think for that it is hard to know whether the virus isolated from the person in Marion Falco, CNN Atlanta forgive me for that, if you are not requiring testing in the countries that already have well established numbers of cases, then how are you distinguishing between seasonal flu and this particular flu. I mean how are you going to separate the numbers?
: My question may be a little basic but if you are not, and so Dr Fukuda
the guidance comes out, what it will suggest is what countries are to do is tailor down their testing so that they are not trying to test everybody but certainly keeping up testing of some people for exactly the kinds of reasons that you bring up. When people get sick with an influenza-like illness it will be important for us to know whether is it caused by the pandemic virus or whether is caused by seasonal viruses. What we are indicating is that if you ratchet down the level of testing we will still be able to figure that out and so we do not need to test everybody for that, but we will continue to recommend some level of testing – at a lower level of people who continue to get sick.
 : It is not that we are recommending not doing any testing at all. In fact when Mika Ruitch, CDF anything. I understand that the meeting in Geneva is still going on about that but we have gone a really huge discussion here in Germany about it and I was wondering whether there is anything you can recommend to countries, whether to order or not already the vaccines.: I have a question about the vaccine, you have not really mentioned Dr Fukuda actually still going on, so I think it is premature to make any reports on that meeting because it has not concluded . The meeting itself will end in recommendations which will go to the Director-General of WHO to look at, so if you can wait for a few days then we will be hearing more about the outcomes and recommendations of that meeting.: This is the SAGE meeting which is going on today and again, the meeting is Tom Mo, in the Southern Hemisphere now? Los Angeles Times: Can you give us a thumbnail description of what is going on Dr Fukuda countries and similar to what we saw in the Northern Hemisphere, it varies a little bit from country to country. For example, a few weeks ago, Australia was reporting pandemic activity occurring quite heavily in some parts of Australia – in the Victoria area – whereas it was at lower levels in other parts of Australia for a while, then began picking up. In South America, there are viruses which have been isolated from most of the countries there, however much of the heaviest activity has occurred in Chile first and then more recently in Argentina. Again we are seeing a kind of mixed picture of activity in the Southern Hemisphere.
In Africa, if we go back a few weeks ago we would have said that there had been no viruses isolated from that continent but as of today 12 countries in the intervening period have reported detecting the virus. So, it is clearly spreading pretty quickly through the Southern Hemisphere; depending on the country you are seeing relatively lower levels of activity and then relatively higher levels of activity in some countries. Overall, I would still point out that for the Southern Hemisphere it is pretty early in their season so we still have a number of weeks to go through for that part of the world.
 : In the Southern Hemisphere we have seen activity occurring in a number of Tala Dolachi,about the surveillance systems and in particular looking at those national indicators. Of all the countries affected, are there any particular countries that WHO is focusing on now in  terms of their inability to keep up to par with the national indicators?Talk Radio Network News: You mentioned earlier that WHO is concerned Dr Fukuda on however is that if there are countries that are requesting help from WHO or from other Member States in terms of assistance to strengthen their surveillance, then we certainly giveas much attention to those countries as possible. This has really paid off.
 If we go back to the couple of years period before this pandemic occurred, for example there is a lot of discussions with the number of states in Africa and there has been actually a great deal of preparedness work which has gone on in that continent, and I can say that the number of laboratories which have the capacity to test for these viruses has really eased ignificantly in Africa. As of today, we have two new National Influenza Centres in Africa – one in Cameroon and one in Côte d’Ivoire – and so, although surveillance is definitely not optimal everywhere in the world, I would say that surveillance is definitely much better than it was three or four years ago. We will continue to try to build that capacity everywhere in the world where the countries are requesting help.
 : No, there is no particular country that we are looking at, and what we do focus
 Aileen Gobay, CBC Montreal:
about the new name of the virus I did not catch it so can you repeat this information for me please?
I am sorry – the line was very bad and when you talked
 Dr Fukuda
a pandemic influenza virus. If you look at the scientific subtype, it is an H1N1 virus, andthe 09 refers to the current time period. Hopefully this will help to distinguish this virus from the seasonal H1N1 viruses.
 We are calling it the pandemic H1N1/09 virus. This refers to the fact that it is Gabriella Sotomayor, Mexican Press Agency:
Tamiflu [oseltamavir]? And of all the cases in Argentina, in general terms, are those cases more severe like in the beginning in Mexico or is it moderate?
How severe are the cases who receive theÂ
Dr Fukuda:
uncomplicated illness. In terms of your second question, it is a little bit difficult for me to answer that so precisely. We know that in Argentina, for example, that most of the cases, as everywhere, have been uncomplicated influenza cases that is to say have not required special medical attention, or special medical care. However it is also true that in the last few weeks, there have been a number of serious cases hospitalizations and some deaths reported.
I am sorry but I do not have exact numbers on my fingertips right now. It is a mixed picture similar to many other countries, I cannot tell you whether it is specifically like Mexico was at the beginning of the pandemic.
I believe all three people have now recovered completely:
